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Director, Enterprise Analytics Provider Performance and Experience

Job Category: Management/Executive

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12549

Salary Range: $171,925.00 (Min.) - $232,100.00 (Mid.) - $292,274.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Director, Enterprise Analytics Provider Performance and Experience provides strategic leadership and operational oversight for one of two primary analytic domains: Provider Performance & Experience or Member Experience & Outcomes. This position plays a pivotal role in enabling data-driven decision-making across the enterprise by translating complex data into actionable insights that inform strategy, improve performance, and advance organizational goals. As a key leader, the Director ensures that analytic strategy and execution are tightly aligned with other cross-functional areas to drive L.A. Care’s enterprise transformation and strategic outcomes.

The Director oversees analytic teams in the design, development, and delivery of insights that span multiple operational and strategic workstreams. Ensures efficiency and effectiveness in work outcomes. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Lead strategic planning and prioritization for analytics efforts within the assigned domain, ensuring alignment with organizational objectives and enterprise priorities.
Oversee and mentor leadership, fostering development of technical, operational, and leadership capabilities.
Ensure delivery of enterprise-level dashboards, reports, and analytic products that support business performance, regulatory compliance, member outcomes, and provider experience.
Partner with executives, strategic pillar leaders, cross-functional stakeholders, and partners to translate organizational priorities into analytics strategies, work plans, and actionable insights.
Support and enforce analytic governance, standardization, and methodology consistency across teams and domains.
Serve as the first point of engagement for domain analytics needs, providing expert guidance, strategic recommendations, and escalation support.
Track and monitor analytic initiatives, ensuring timely delivery, quality, and relevance to business objectives.
Advocate for data-driven decision-making, assuring they are embedded into strategic planning performance management and transformation initiatives across the enterprise and provide thought leadership on analytic strategy, capabilities, and innovation.
Collaborate with key stakeholders to ensure alignment of data architecture, availability, and quality with analytic needs.
Continuously assess enterprise and domain-level analytic capabilities, identifying opportunities for process improvement, automation, and innovation. Support and enforce the development, standardization, and governance of analytic processes and outputs across domains to ensure consistency, accuracy, and quality.
Integrating development and outputs from the Applied AI and Causal Impact Data Science Team into the domain portfolio and roadmap, ensuring predictive and explainable models and program causal impact evaluations are operationalized, actionable, and aligned with business needs. Serving as a primary analytics liaison to stakeholders for the position’s focal analytic domain.
Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews, training, and disciplinary matters for direct reports.
Conduct strategic planning for resource management in order to meet current and future departmental and enterprise-wide goals.
Develop and manage department budget, monitor expenditures and ensure financial sustainability.
Perform other duties as assigned.

Education Required

Bachelor's Degree

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree

Experience

Required: At least 9 years of progressively responsible experience in analytics.

At least 7 years of experience supervising/managing staff.

Experience leading teams, projects, initiatives, or cross-functional groups.

Experience with SQL, Python, and Tableau (or comparable BI/visualization tools) in a server-based analytics environment.

Experience integrating outputs from advanced analytics or data science models into operational analytic portfolios.

Proven experience leading and executing analytics strategies across at least one of the following managed care domains: Authorizations, Claims and Medical Cost Driver Analytics, Provider Network Strategy Analytics, or Risk Adjustment and Encounter Analytics.

Experience integrating analytic insights into provider engagement, performance improvement, and contracting strategies.

Preferred: Experience with stakeholder engagement, executive reporting, and strategic initiative management.

Experience implementing and enforcing enterprise-level analytic standards and governance.

Experience with predictive modeling, cost driver analytics, and provider performance dashboards to support strategic decision-making.

Skills

Required: Ability to lead multiple Managers and analytic teams, set priorities, and align work with enterprise strategy. Deep knowledge of healthcare operations, quality measurement, risk adjustment, provider networks, provider performance, population health and member experience. Demonstrated ability to set enterprise analytic priorities, translate strategy into execution, and deliver actionable insights to executive leadership. Knowledge of managed care, Medicare Advantage, Medi-Cal, commercial insurance operations, and compliance reporting. Knowledge of prescriptive analytics, predictive risk modeling, or causal impact modeling. Ability to support and enforce the development, standardization, and governance of enterprise analytics outputs. Ability to synthesize complex findings into actionable recommendations and communicate effectively with senior leaders. Ability to provide oversight of multiple complex analytic initiatives, ensuring on-time and high-quality delivery. Ability to partner effectively across Information Technology (IT), Data Governance, operational and clinical teams, and business stakeholders. Ability to mentor Senior Managers, Managers, and analytic leaders, building enterprise analytic capability. Excellent written and verbal communication skills. Strong negotiation and interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Strong strategic and operational acumen, with the ability to collaborate across business areas, anticipate analytic needs, and ensure alignment with enterprise priorities and transformation initiatives. Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.

Demonstrated ability to align operational, financial, and clinical analytics to improve provider performance, experience, and value-based outcomes.

Preferred: Advanced knowledge of visualization design, executive dashboards, and Key Performance Indicators (KPI) frameworks. Strategic planning skills for enterprise analytic initiatives. Change management expert knowledge to drive adoption of standardized processes and tools. Deep understanding of provider network contracting, credentialing, utilization management, and claims operations. Knowledge of managed care regulations, compliance requirements, and operational reporting standard.

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified Professional in Healthcare Quality (CPHQ)

Project Management Professional (PMP)

Snowflake SnowPro Core Certification

Other analytics or data-focused certifications (e.g., Microsoft Certified: Data Analyst Associate, Python for Data Science certifications)

Required Training

Preferred:

Snowflake or SnowPro training

Healthcare analytics training (e.g., HEDIS, Risk Adjustment, MLTSS)

Executive leadership or strategic analytics training

Training in data governance, reproducibility, and analytic methodology best practices

Familiarity with predictive modeling, prescriptive analytics, and causal inference methods

Physical Requirements

Light

Additional Information

Domain Focus: Provider Performance & Experience Analytics

Required:

Proven experience leading and executing analytics strategy across at least one of the following managed care domains: Authorizations, Claims and Medical Cost Driver Analytics, Provider Network Strategy Analytics, or Risk Adjustment and Encounter Analytics.

Demonstrated ability to align operational, financial, and clinical analytics to improve provider performance, experience, and value-based outcomes.

Experience integrating analytic insights into provider engagement, performance improvement, and contracting strategies.

Preferred: Experience with predictive modeling, cost driver analytics, and provider performance dashboards to support strategic decision-making.

Deep understanding of provider network contracting, credentialing, utilization management, and claims operations.

Knowledge of managed care regulations, compliance requirements, and operational reporting standard.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program

Nearest Major Market: Los Angeles

Job Segment: Claims, Medicare, Performance Management, Insurance, Healthcare, Human Resources

#J-18808-Ljbffr","

Director, Enterprise Analytics Provider Performance and Experience

Job Category: Management/Executive

Location: Los Angeles...",["B","2273347264"],"5 hours ago","/jobs/2273347264-director-enterprise-analytics-provider-performance-and-experience","/jobs?location=Los+Angeles",{"_429":428,"_434":526,"_452":453,"_444":445,"_243":527,"_441":528,"_427":428,"_111":529,"_431":194,"_433":194,"_454":453,"_442":467,"_425":530,"_455":456,"_430":118,"_476":522,"_460":531,"_478":529,"_480":467,"_482":483,"_484":524,"_486":532},["D",1771476358000],"A leading healthcare organization is seeking a Director of Enterprise Analytics Provider Performance and Experience to provide strategic leadership in analytics. This role offers opportunities to enhance data-driven decision-making and improve provider performance through effective management of analytic teams. The ideal candidate should have at least 9 years of experience in analytics, strong leadership skills, and expertise in SQL, Python, and Tableau. The position is full-time and located in Los Angeles, CA.
#J-18808-Ljbffr","A leading healthcare organization is seeking a Director of Enterprise Analytics Provider Performance and Experience to provide strategic leadership...","Director of Analytics: Provider Performance & Experience",["B","2625608462"],"/jobs/2625608462-director-of-analytics-provider-performance-experience","/jobs?keyword=Director+of+Analytics%3A+Provider+Performance+%26+Experience",{"_429":428,"_434":534,"_452":453,"_444":445,"_243":535,"_441":536,"_427":428,"_111":537,"_431":194,"_433":194,"_454":453,"_442":538,"_425":539,"_455":456,"_430":115,"_476":540,"_460":541,"_478":537,"_480":538,"_482":483,"_484":542,"_486":543},["D",1770058800000],"Director, Claims Administration

Job Category: Management/Executive

Department: Claims Integrity

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12790

Salary Range: $135,136.00 (Min.) - $175,676.00 (Mid.) - $216,218.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Director, Claims Administration, governs enterprise outcomes and risk controls, introducing a preventative orientation and regulatory accountability. This position is responsible for leading the end-to-end claims ecosystem, including claims adjudication, claims adjustments (escalations, disputes, general adjustments, and litigation-related requests), and strong focus on preventative controls through the Service Validation Unit (SVU). This role ensures timely, accurate, and complaint processing across all lines of business while strengthening upstream quality, embedding consistent control points, and reducing operational rework.

The Director has ownership of claims regulatory compliance and audit readiness. This position oversees daily production, inventory management, adjustment workflows, regulatory turnaround requirements, benefit and authorization interpretation, provide payment accuracy, and operational readiness for benefit, system, or regulatory changes. The role serves as an operational expert on managed care payment rules provider contracts, regulatory requirements, and claims operational dependencies.

The Director partners closely with cross functional teams to ensure end-to-end accuracy and operational integrity. This position fosters a culture of accountability, transparency, operational consistency, and continuous improvement.

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Develops strategic plans, drives change and influences critical business outcomes.

Duties

Translates organizational expectations into disciplined operational execution by creating predictable workflows, establishing strong preventative control environments, and ensuring that claims processing is accurate, timely, and complaint. Strengthens upstream quality, improves consistency through standardized processes, ensures rigorous adherence to regulatory and contractual requirements, and supports an operational model that aims to remove rework, prevents defects, and supports high-performing administrative operations. Through ownership of regulatory compliance and audit readiness perspective, provides strategic and operational leadership for all aspects of claims adjudication across all lines of business. Monitors daily, weekly, and monthly production performance to ensure accuracy, timeliness, and regulatory compliance. Oversees examiner productivity models, workload balancing, Quality Assurance performance, and inventory trending to ensure strong operational predictability. Ensures benefit, authorization, eligibility, and provider data issues are resolved quickly and consistently, with emphasis on preventing repeat defects. Supports enterprise initiatives requiring claims operational expertise. Leads all adjustment workflows, including escalations, provider disputes, general adjustments, and litigation-related claims review. Ensures all regulatory turnaround times (TATs) and provider/member notice requirements are consistently met, documented, and monitored. Services and the operational escalation point for high-visibility or high-complexity claim issues, including those involving regulators, legal, provider groups, or executive leadership. Develops standardized adjustment pathways that improve cycle time and reduce manual rework.

Establishes and leads the Service Validation Unit (SVU) to function in a strategic, proactive and preventative manner by independently validate that billed services were authorized, medically supported, accurately represented, and provided/received prior to payment. Ensures SVU findings translate into upstream, corrections, system or process improvements, and improved preventive controls. Develops and leads initiatives to improve first-pass accuracy, reduce rework, shorten cycle time, and advance operational maturity. Participates in and partners through quality review processes to ensure adherence to regulatory and contractual processing standards. Oversees root-cause analysis of defects or variances, ensuring permanent corrective actions and improved upstream controls. Partners with stakeholder departments on regulatory reviews, corrective actions, and audit responses. Ensures the accuracy and timeliness of responses to regulators and external partners.

Duties Continued

Directs production, quality, and operational performance reporting, identifying trends, risks, and improvement opportunities. Ensures reporting supports proactive decision-making and enables early identification of potential inventory or compliance risks. Partners to establish/refine dashboards for visibility into accuracy, timeliness, adjustments, disputes, and SVU outcomes.

Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.

Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals. Identifies and actualizes enhancements to support company vision.

Develops and maintains relationships with key stakeholders. Leads discussions on policy operationalization and oversees key policy perspective sharing.

Ensures strong technical capability, a culture of accountability, and consistent performance. Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement. Performs additional duties as assigned.

Education Required

Bachelor's Degree

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Business Administration or Related Field

Experience

Required:

At least 7 years of healthcare claims (Medicare, Medicaid, and Commercial) experience.

At least 5 years of experience leading, supervising and/or managing staff.

Experience in Medicaid, Medicare, and Commercial managed care lines of business.

Demonstrated experience leading claims adjudication, adjustments, disputes, escalations, and related functions.

Extensive experience interpreting provider contracts, payment methodologies, and managed care benefit structures

Experience handling complex claim review, root-cause evaluation, adhering to regulatory timeliness requirements, and ensuring accuracy.

Significant experience administering quality review programs and implementing sustainable operational improvements.

Experience supporting litigation, state or federal inquiries, and regulatory audits.

Demonstrated experience with high complexity claims review and RCA.

Preferred:

Experience leading a service validation or similar preventive quality/control unit.

Skills

Required:

Strong understanding of managed care contracts, benefit structures, payment methodologies, and authorization requirements.

Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.

Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.

Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.

Deep study and understanding of managed care contracts and payment methodologies and provide contract interpretation.

Strong project leadership and management skills required; ability to manage multiple priorities, complex workflows, and high-volume environments.

Proficiency with Microsoft Office and data/reporting tools.

Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.

Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas.

Must be able to present findings to various levels of management, across all organizations.

Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.

Demonstrated ability to make sound and timely decisions.

Demonstrated ability to adapt to changing situations and adjust strategies accordingly.

Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.

Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.

Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified Professional Coder (CPC)

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

","Director, Claims Administration

Job Category: Management/Executive

Department: Claims Integrity

Location:

Los A...","Director, Claims Administration","Los Angeles, California, United States, 90079",["B","2408835939"],"16 days ago","/jobs/2408835939-director-claims-administration","/jobs?location=Los+Angeles%2C+California%2C+United+States%2C+90079","/jobs?keyword=Director%2C+Claims+Administration",{"_429":428,"_434":545,"_452":453,"_444":445,"_243":546,"_441":547,"_427":428,"_111":548,"_431":432,"_433":194,"_454":453,"_442":443,"_425":549,"_455":456,"_430":121,"_476":477,"_460":550,"_478":548,"_480":443,"_482":483,"_484":485,"_486":551},["D",1771286400000],"

A leading healthcare organization in Los Angeles seeks an Enterprise Support Analytics Solutions and Data Analyst III to develop advanced analytic solutions that enhance organizational performance. This role involves designing ETL pipelines and dashboards, translating complex data into actionable insights, and mentoring teams. Candidates should possess strong analytics experience and proficiency in BI tools like Tableau and Power BI. A Bachelor's degree is required, with a Master's preferred.

#J-18808-Ljbffr

","

A leading healthcare organization in Los Angeles seeks an Enterprise Support Analytics Solutions and Data Analyst III to develop advanced analyt...","Senior Enterprise Analytics & Data Insights Analyst",["B","2620497236"],"/jobs/2620497236-senior-enterprise-analytics-data-insights-analyst","/jobs?keyword=Senior+Enterprise+Analytics+%26+Data+Insights+Analyst","actionData","errors"]